Exploring cultural understandings of mental health disorders in multi-ethnic societies of Brunei Darussalam, Malaysia, and Singapore: a scoping review

Introduction: Mental health (MH) and mental health disorder(s) (MHD) have evolved into a global health agenda as disparities exist in the access and utilisation of MH services within and across countries in the Global North-South. Rationale: Socio-cultural factors contribute to these disparities and in the age of globalisation, cross-cultural validity of the evidence that informs the global and local policies and practices of mental health care (MH-care) must be considered to meet the needs of the multi-ethnic, multi-religious, and multicultural societies of the world. Yet, less is known about the cultural understandings of MHD and their expressions in multi-ethnic societies of the Global South. Problem statement: Brunei Darussalam, Malaysia, and Singapore are countries in the Global South with multi-ethnic societies that share similar national culture while maintaining the individual identity of each cultural groups. However, no scoping review has been done looking at the cultural understandings of MHD within and across these three countries. Research Question: What is known about the different cultural understandings of MHD in the multi-ethnic societies of Brunei Darussalam, Malaysia, and Singapore?Research Objectives: (i) To describe the published research on MH in the selected countries; (ii) To describe how ethnic groups in the selected countries understand MHD; (iii) To describe literature on cultural competency of MH-care providersMethods: This study employed the Arksey and O’Malley (2005) protocol for scoping review and the PRISMA-ScR checklist. Keywords such as ‘mental illness’, ‘culture’, and ‘Malaysia’ were connected using Boolean operators ‘AND’ or ‘OR’ to form search strings for input into electronic database: PsycINFO, CINAHL Complete, MEDLINE, Sage Journals, Academic Search Ultimate, Google Scholar, and Google Search Engine. Twenty-seven (n=27) publications from 2014 onwards with full-text available in English Language and relevant to the research objectives were included for extraction and analysis. Findings: MHD is perceived as weakness rather than illness in all the major ethnic groups, however, discrepancies exist in the level of MHD stigma and negative attitudes. The Chinese seem to endorse psychosocial and personality causes for MHD while the Malays and Indians endorse physical and supernatural causes. A common practice of help-seeking is from family, friends and traditional/religious healers - the latter more common among Malay Muslims. Socio-cultural norms such as face saving and punishments for past sins contribute to MHD stigma. Cultural awareness and sensitivity were seen as attributes of cultural competency. Language barriers and misalignment of cultural values between practitioners and clients are some of the challenges to achieving cultural sensitivity. Discussion: Research on MH and MHD in ASEAN is scarce. Less is known about the cultural expression of MHD in Brunei Darussalam, Malaysia and Singapore. Indians along with other minor groups and other traditional healing systems are least reported in the literature. No data was found on the initiatives to bridge the gaps between mainstream MH-care and traditional healing. Conclusion and Recommendations: Literature in other local dialects (Bahasa Melayu, Mandarin, Tamil etc.) were not searched and included. Data older than 2014 and those in the context of other countries in the Malay Archipelago (Indonesia, south of Thailand, and south of Philippines) could be included in future review studies. Possible gaps for future investigations include but not limited to: (i) Baseline nation-wide mental health literacy (MHL) level in Brunei Darussalam and Malaysia; (ii) Epidemiology of MHD in Brunei Darussalam; (iii) MHD expressions in PLMHD, especially idioms of distress, within and across the population; (iv) The socio-cultural determinants and cultural understandings of MHD among the Indian and other minor ethnic groups within all three countries; (v) Other traditional healing systems such as Ayurvedic medicine, Chinese medicine, local indigenous medicine etc.; (vi) Strategies to bridge the gap and integrate traditional healing systems into mainstream psychiatric/psychological care; (vii) Cultural competency in MH-care in all three countries.